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Can poorer outcome after severe brain injury be predicted by poorer responsiveness in the acute recovery period?
Shiel, A. & WILSON, B.A.
Brain Impairment, 6(2), p. 133, 2005
Year of publication:
Poorer outcome in terms of patients remaining in the vegetative state or the minimally conscious state is decided upon many months after the initial insult. By the time this becomes clear, inappropriate rehabilitation or indeed no rehabilitation may have been offered. The aim of this study was to evaluate levels of responsiveness in the acute stages of recovery from severe traumatic brain injury related to overall outcome four years later. Methods: This was a follow-up study of patients recruited to a prospective observational study of severe head injury carried out four years earlier. Of the original 88 cases, 66 were contacted and 41 patients or their carers agreed to participate in a follow-up study. Of these, eight met the criteria for the vegetative state (VS) or minimally-conscious state (MCS). Data collected in the prospective study using the Wessex Head Injury Matrix were examined together with data from the outcome study to ascertain whether any behaviours having potential predictive value could be identified. Correlation, regression and Mann-Whitney tests were used to evaluate the data. Results: Time taken to achieve a number of early behaviours differed significantly between the VS/MCS group and the other groups. These were duration of coma (p < .01); obeying command (p = .01); watching person in line of vision (p < .01); looking at person giving attention (p < .01) and focusing on person talking (p < .05). Conclusions: These results suggest that certain behaviours observed in the acute recovery period after severe head injury may be predictive of poorer outcome. However, the results can only be considered to be speculative and further research to confirm or refute them is required.Abstract only published - Paper given at the Conference on Neuropsychological Rehabilitation, July 11-12, 2005, Galway Ireland.